Braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in patients with unruptured complex intracranial aneurysms

Zhang, Jie; He, Ling; Xia, Xun; Zhang, Lie; Yu, Kai

doi:10.1016/j.clinsp.2023.100202

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Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100202 copy

Braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in patients with unruptured complex intracranial aneurysms

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Purposes:

Braided and laser-cut stents both are efficacious and safe for coiling intracranial aneurysms. The study aimed to compare outcomes following braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in 266 patients who were diagnosed with unruptured intracranial aneurysms of different types and locations.

Methods:

Patients with unruptured complex intracranial aneurysms underwent braided (BSE cohort, n = 125) or laser engraved (LSE cohort, n = 141) stent-assisted embolization.

Results:

The deployment success rate was higher for patients of the LSE cohort than those of the BSE cohort (140 [99%] vs. 117 [94%], p = 0.0142). Seventy-one (fifty-seven percentages) and 73 (52%) were coil embolization procedure success rates of the BSE and the LSE cohorts. Periprocedural intracranial hemorrhage was higher in patients of the BSE cohort than those of the LSE cohort (8 [6%] vs. 1 [1%], p = 0.0142). Four (three percentages) patients from the LSE cohort and 3 (2%) patients from the BSE cohort had in-stent thrombosis during embolization. Permanent morbidities were higher in patients of the LSE cohort than those of the BSE cohort (8 [6%] vs. 1 [1%], p = 0.0389). Higher successful procedures (76% vs. 68%) and fewer postprocedural intracranial hemorrhage (0% vs. 5%) and mortality (0% vs. 5%) were reported for patients of the BSE cohort in posterior circulation aneurysmal location than those of the LSE cohort. Laser engraved stent has fewer problems with deployment and may have better periprocedural and follow-up outcomes after embolization.

Conclusions:

Braided stent-assisted embolization should be preferred when the aneurysm is present in the posterior circulation.

Keywords:
Braided stents; Endovascular therapy; Intracranial aneurysms; Laser-cut stents; Magnetic resonance angiography; Stent-assisted coil embolization; Subarachnoid hemorrhage

HIGHLIGHTS

Laser engraved stent has easy deployment & has better follow-up outcomes.

Success of coil embolism would be higher for braided stent-assisted embolization.

Braided stent should be preferred for the posterior circulation aneurysm.

			Cohorts
Parameters		Total	BSE	LSE
Stent-assisted embolization		Braided or Laser engraved	Braided	Laser engraved	Comparisons between cohorts
Numbers of patients		266	125	141	p-value	95% Cl
Gender	Male	155 (58)	70 (56)	85 (60)	0.5338 (Fisher’s exact test)	0.7058 to 1.177
	Female	111 (42)	55 (44)	56 (40)
Age (years)		62 (67–57)	63 (67–58)	61 (67–55)	0.1115 (Mann-Whitney test)	N/A
Comorbidities
Hypertension		119 (45)	57 (46)	62 (44)	0.8059 (Fisher’s exact test)	0.8016 to 1.337
Diabetes		22 (8)	11 (9)	11 (8)	0.8257 (Fisher’s exact test)	0.6900 to 1.660
Hyperlipidemia		80 (30)	35 (28)	45 (32)	0.5058 (Fisher’s exact test)	0.6769 to 1.208
Patient’s behavior
Smoking	Current	19 (7)	11 (9)	8 (6)	0.3584 (χ²-test; df: 2)	N/A
	Previous	27 (10)	15 (12)	12 (9)
	No smoker	220 (83)	99 (79)	121 (86)

			Cohorts
Parameters		Total	BSE	LSE
Stent-assisted embolization		Braided or laser engraved	Braided	Laser engraved	Comparisons between cohorts
Numbers of patients		266	125	141	p-value	95% CI
Aneurysmal location	Anterior circulation	226 (85)	104(83)	122(87)	0.4942 (Fisher’s exact test)	0.6321 to 1.215 (using the approximation of Katz.)
	Posterior circulation	40 (15)	21(17)	19(13)
Aneurysm size (mm)		5.5 (7–4)	5 (7–3.5)	6 (7–4)	0.3159 (Mann-Whitney test)	N/A
Neck size (mm)		4 (5–3)	4 (5–3)	4 (5–3)	0.5666 (Mann-Whitney test)	N/A
Depth-to-neck (mm)		1.2 (1.3–1)	1.2(1.3–1)	1.2 (1.3–1)	0.46 (Mann-Whitney test)	N/A
Aneurysm type	Bifurcation	187 (70)	90 (72)	97 (69)	0.5929 (Fisher’s exact test)	0.8140 to 1.450 (using the approximation of Katz.)
	Side-wall	79 (30)	35 (28)	44 (31)
Packing density (%)		33.35±0.38	32.63±0.58	33.98±0.48	0.073 (unpaired t-test)	–0.1265 to 2.820 (df: 264)

			Cohorts
Parameters		Total	BSE	LSE
Stent-assisted embolization		Braided or laser engraved	Braided	Laser engraved	Comparisons between cohorts
Numbers of patients		266	125	141	p-value	95% CI	df
Follow-up period (months)		37.71 ± 0.29	37.69 ± 0.33	37.74 ± 0.44	0.9301 (unpaired t-test with Welch correction)	–1.062 to 1.161	247
Deployment success		257 (97)	117 (94)	140 (99)^a a Significant higher.	0.0142 (Fisher’s exact test)	0.3922 to 0.6689 (using the approximation of Katz.)	N/A
Results of procedure	Successful procedure	144 (54)	71 (57)	73 (52)	0.46 (Fisher’s exact test)	0.8597 to 1.443 (using the approximation of Katz.)	N/A
	Unsuccessful procedure	122 (46)	54 (43)	68 (48)

		Cohorts
Parameters	Total	BSE	LSE
Stent-assisted embolization	Braided or laser engraved	Braided	Laser engraved	Comparisons between cohorts
Numbers of patients	266	125	141	p-value	95% CI
Periprocedural intracranial hemorrhage	9 (3)	8 (6)^a a Braided stent-assisted adverse effect.	1 (1)	0.0142	1.495 to 2.550
Postprocedural intracranial hemorrhage	6 (3)	5 (4)	1 (1)	0.1023	1.233 to 2.644
Permanent morbidity	9 (3)	1 (1)	8 (6)^b b Laser engraved stent-assisted adverse effect.	0.0389	0.03611 to 1.468
Mortality	4 (2)	1 (1)	3 (2)	0.6249	0.09625 to 2.899

Parameters		Cohorts
Aneurysmal location		Anterior circulation					Posterior circulation
Cohorts		Total	BSE	LSE	Comparisons between cohorts		Total	BSE	LSE	Comparisons between cohorts
Numbers of patients		226	104	122	p	95% CI	40	21	19	p	95% CI
Results of procedure	Successful procedure	115 (51)	55 (53)	60 (49)	0.5958	0.8161 to 1.438	29 (73)	16 (76)	13 (68)	0.7271	0.5873 to 2.508
	Unsuccessful procedure	111 (49)	49 (47)	62 (51)			11 (27)	5 (24)	6 (32)
Postprocedural intracranial hemorrhage		4 (2)	5 (4)	0 (0)	0.02	1.920 to 2.572	1 (5)	0 (0)	1 (5)	0.475	Infinity to Infinity
Mortality		3 (2)	1 (1)	2 (2)	0.999	0.1447 to 3.599	1 (3)	0 (0)	1 (5)	0.475	Infinity to Infinity

			Cohorts
Parameters		Total	BSE	LSE
Stent-assisted embolization		Braided or laser engraved	Braided	Laser engraved	Comparisons between cohorts
Numbers of patients		266	125	141	p-value	df
Recanalization	Within 6 months	60 (23)	27 (22)	23 (16)	0.2928 (χ²-test)	3
	6 to 12 months	41 (15)	21 (17)	20 (14)
	12 to 18 months	33 (12)	18 (14)	15 (11)
	Not recanalized	132 (50)	64 (51)	83 (59)
Numbers of recanalization		1 (1–1)	1 (1–1)	1 (1–1)	0.4576 (Wilcoxon matched-pairs signed-ranks test)	N/A

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[1] *Corresponding author. E-mail address:xun.xia@aliyun.com (X. Xia).